Reproducibility and uptake time dependency of volume-based parameters on FDG-PET for lung cancer

Abstract

Background: Volume-based parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), on F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) are useful for predicting treatment response in nonsmall cell lung cancer (NSCLC). We aimed to examine intra- and inter-operator reproducibility to measure the MTV and TLG, and to estimate their dependency on the uptake time.

Methods: Fifty NSCLC patients underwent preoperative FDG-PET. After an injection of FDG, the whole body was scanned twice: at the early phase (61.4 ± 2.8 min) and delayed phase (117.7 ± 1.6 min). Two operators independently defined the tumor boundary using three different delineation methods: (1) the absolute SUV threshold method (MTVp and TLGp; p = 2.0, 2.5, 3.0, 3.5), (2) the fixed% SUVmax threshold method (MTVq% and TLGq%; q = 35, 40, 45), and (3) the adaptive region-growing method (MTVARG and TLGARG). Parameters were compared between operators and between phases.

Results: Both the intra- and inter-operator reproducibility were high for all parameters using any method (intra-class correlation > 0.99 each). MTV3.0 and MTV3.5 resulted in a significant increase from the early to delayed phase (P < 0.05 for both), whereas MTV2.0 and MTV2.5 neither increased nor decreased (P = n.s.). All of the MTVq% values significantly decreased over time (P < 0.01), whereas MTVARG and TLG with any delineation method increased significantly (P < 0.05).

Conclusions: High reproducibility of MTV and TLG was obtained by all of the methods used. MTV2.0 and MTV2.5 were the least sensitive to uptake time, and may be good alternatives when we compare images acquired with different uptake times, although applying constant uptake time is important for volume measurement.

Keywords: FDG-PET; Lung cancer; Metabolic tumor volume; Reproducibility; Total lesion glycolysis.

Fig. 1

a Regions of interest defined by Operator-1 (solid line) and Operator-2 (dashed line). b Corresponding CT slice

Fig. 2

Bland-Altman plots showing the parameter changes between the early phase and delayed phase of the MTV, which is a general threshold value. MTV_2.5 had few parameter changes (a), MTV_40% decreased (b), and MTV_ARG increased (c) from the early phase to the delayed phase

Fig. 3

Bland-Altman plots showing the parameter changes between the early phase and the delayed phase of TLG, which is general threshold value. Unlike Fig. 2, TLG obtained by any delineation method was increased at the delayed phase (a-c)